Informal employment and health status in Central America.

María López-Ruiz,Fernando G. Benavides,Lucía Artazcoz,José Miguel Martínez,Marianela Rojas

doi:10.1186/s12889-015-2030-9

Abstract

BackgroundInformal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low- and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60 % of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment.MethodsEmployment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract -only for employees- (written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables.ResultsPoor self-perceived health was reported by 34 % of women and 27 % of men, and 30 % of women and 26 % of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95 % CI: 1.13-1.67; men, aOR: 1.36, 95 % CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes.ConclusionsOur results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.

Highlights

Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world
Description of the sample A total of 8,823 Central American workers involved in non-agricultural activities were analyzed (48.5 % women)
The employment profiles with a higher number of workers were self-employed without social security coverage (34.7 % of women and 28.2 % of men) and employees with social security coverage and a written contract (23.3 % and 24.5 % of women and men, respectively)

Summary

Introduction

Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. López-Ruiz et al BMC Public Health (2015) 15:698 to refer to informality is that of “informal economy” as adopted by the International Labor Organization (ILO) in 2002 This definition is based on both the economic production units and employment relations, and defined as “all economic activities by workers and economic units that are -in law or in practice- not covered or insufficiently covered by formal arrangements”. In Central America, the structural adjustment programs adopted during the economic crisis of the 1980s have meant an opening-up of their economies to external markets This caused the restructuring of the labor market including deregulation of the formal sector, increase of unemployment, and consolidation of the informal economy [7, 9]. It is important to take into account that women, young people, the elderly, and the poor make up a major portion of the informal economy [7, 12]

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